=====================================================
General NPI Number Information
=====================================================
NPI Number | 1912285388
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ASHLEY L LUNDY LAC.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/02/2011
-----------------------------------------------------
Last Update Date | 02/03/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 104 S CHALKVILLE RD STE 105
-----------------------------------------------------
City | TRUSSVILLE
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35173-1408
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 205-661-0054
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 104 S CHALKVILLE RD STE 105
-----------------------------------------------------
City | TRUSSVILLE
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35173-1408
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 56-610-0542
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171100000X
-----------------------------------------------------
Taxonomy Name | Acupuncturist
-----------------------------------------------------
License Number | AP 2869
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------